Clinical practicum

Building on work done in the clinical practicum setting this week, and looking toward your ongoing work as an MSN, address the following questions:

1. What aspects of your proposal may be used at the site? (clinical site)

2. What aspects of your proposal may be used in your ongoing work as an MSN?

Integrating Change into Practice

  Aspects of my proposal that can be used at the clinical site

Research indicates that diabetes Type 2 incidences are increasing at alarming rates (LeClair, 2013).  The current management standard for diabetes type 2 is the use of pharmacological therapy, which is balanced with diet and exercises to maintain effective glycaemic control and to avoid associated complications. This is important because higher glycaemic levels are linked directly to higher rates of health complications. The glycaemic control is monitored by the levels of glycosylated haemoglobin (HbA1c) (Stranieri, Yatsko, Jelinek & Venkatraman, 2015).

 At the clinical site, the diabetes team should ensure that they have validated screening protocols for diabetes type 2. The evidence based research recommended HbA1c levels is 7.5% as levels above this threshold is associated with risks for hyperglycaemia (Tomar, 2016).  It is recommended that HbA1c test is performed at least twice every year for patients who adhere to treatment goals and quarterly for patients not meeting glycaemic goals (Stranieri, Yatsko, Jelinek, & Venkatraman, 2015). However, Evidence based practice (EBP) recommends use of individualized insulin therapy.

Additionally, EBP indicates that healthcare provider should conduct comprehensive assessment of the family functioning such as parental psychopathology, communication, parental support and involvement, and self-care behaviours and attitudes. This helps in designing the most effective patient education plan and implementation of EBP that improves coping strategies for diabetes Type 2 (LeClair, 2013).

  Aspects of my proposal that can be used in the ongoing work as an MSN

Evidence based research indicates that physical activity and diet are the most important aspect in controlling ABCs of Type 2 diabetes. The ABCs includes (HbA1c, Blood pressure and Cholesterol). Effective management of the glycated haemoglobin (HbA1c) and to attain stable blood sugar control, it is very important for the patients to understand how to balance the food intake and physical activity. This involves patient education using teach back technique (Reinehr, 2013).

Anticipatory patient education and counselling of lifestyle modification are routine care is critical especially during the developmental transitions. Evidence base studies indicate that successful management of diabetes type 2 will need heterogeneous interventions including cognitive behavioural therapy, general diabetes education and skills training. This increases diabetes knowledge which correlates with significant improvements on emotional, physical and developmental outcomes (Stranieri, Yatsko, Jelinek & Venkatraman, 2015).

The healthcare provider in Doctor Office setting should interact with the other multidisciplinary healthcare professionals including dieticians, pharmacists, nurses, physical therapists, psychiatrists, laboratory technicians and physicians. While an MSN can give an outline on management of diabetes type 2, it is important to refer the patients to the experts for detailed patient education.  This has been found to be effective in improving patient knowledge of diabetes, medication adherence, beneficial stress management attitude and self-care ability and glycaemic control (Fain, 2012).

The training topics that should be covered continuously include the action of insulin, its administration, dosage, blood glucose monitoring, ketone testing and diabetic ketoacidosis (DKA). Additionally, the patient should be educated on detection and treatment of hypoglycaemia (Stranieri, Yatsko, Jelinek & Venkatraman, 2015). Nutrition therapy training should cover what the patient should eat and the quantity. Exercises education includes outlining the effective exercise duration, what to do before and after exercises. It is important to initiate discussion with patient and their families on challenging factors associated with coping strategies.  Examples of these factors includes the psychological issues, concerns on body shape or size, substance use, and generally issues on patient life (Tomar, 2016).


LeClair, E. (2013). Type 1 Diabetes and Physical Activity in Children and Adolescents. Journal Of Diabetes & Metabolism, 01(S10). Fain, J. (2012). National Standards for Diabetes Self-Management Education and Support: Updated and Revised 2012. The Diabetes Educator, 38(5), 595-595.

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